Computed Tomography Artifacts Research Articles

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation.

To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein. Ex vivo mechanical evaluation. Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC). Sterile saline 0.9% was instilled into the lumen of the EJV until a pressure of 100 mm Hg was reached. Failure mechanism and luminal pressure at failure were compared between groups. Medium clips failed less often than medium-large clips (P < .001) and consistently sustained 100 mm Hg without failing. Three-layer cellophane bands were 4.1 times more likely to fail than 4-layer bands (P = .003, CI 1.6-10.2) and failed at lower pressures (28.32 ± 3.59 mm Hg and 44.81 ± 6.51 mm Hg, respectively, P = .027). Failure rates of the cellophane band constructs did not differ whether secured with PLLC or with TLC (P = .635) or with 25% vs 50% attenuation (P = .780). A single medium clip withstood physiological forces and secured a cellophane band at up to 50% attenuation. A 3-layer cellophane band was more likely to fail compared with a 4-layer cellophane band. These ex vivo results provide evidence to support the application of a 4-layer cellophane band secured with a single medium PLLC or TLC for portosystemic shunt attenuation. A single medium PLLC should be used to eliminate computed tomography artifacts during postoperative evaluation of shunt closure.

Treatment planning dose accuracy improvement in the presence of dental implants

Streaking artifacts in computed tomography (CT) scans caused by metallic dental implants (MDIs) can lead to inaccuracies in dose calculations. This study quantifies and compares the effect of MDIs on dose distributions using the collapsed cone convolution superposition (CCCS) and Monte Carlo (MC) algorithms, with and without correcting for the density of the MDIs. Ion chamber measurements were taken to test the ability of the algorithms in Pinnacle3 and Monaco to calculate dose near high-Z materials. Nine previously treated patients with head and neck cancer were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient, a plan was optimized and calculated using the Pinnacle3 treatment planning system (TPS). Two dose calculations were performed for each patient: one with overridden densities of the MDI and CT artifacts and one without overridden densities of the MDI and CT artifacts. The plans were then exported to the Monaco TPS and recalculated for the same number of monitor units (MUs) using its MC dose calculation algorithm. The changes in dose to the planning target volume (PTV) and surrounding healthy tissues were examined between all the plans using VelocityAI. For the ion chamber measurements, when correct density information was used, Monaco was within 3% of the measured values, whereas the doses calculated in Pinnacle3 varied up to 7%. The CCCS algorithm in Pinnacle3 calculated only a significant decrease in PTV coverage for 1 patient when the densities were overridden. The MC algorithm in Monaco was able to calculate a significant change in PTV coverage for five of the patients when the density was overridden. Additionally, when healthy tissues affected by streaking artifacts were assigned the correct density, cumulative (from all the fractions) point doses increased up to 46.2 Gy. Not properly accounting for MDIs can impact both the high-dose regions (PTVs) and surrounding healthy tissues. This study demonstrates that if MDIs and the artifacts are not appropriately accounted for by contouring and assigning to them the correct density, there is a potential risk of compromising the quality of the plan regarding PTV coverage and dose to healthy tissues.

Determination of the optimal imaging parameters in industrial computed tomography for dimensional measurements on monomaterial workpieces

Industrial computed tomography (CT) plays a key role in 3D coordinate metrology as an alternative to conventional coordinate measuring machines. CT measurement uncertainty depends on the setup parameters with which CT scans are performed. Currently, there is no established model that can describe the relationship between CT setup parameters and measurement uncertainty, and thus determine the optimal settings for a given measurement task. In practice, CT users choose setup parameters intuitively causing high variability in the measurement results. In this study, we enhance and validate an analytical method for optimizing imaging parameters. The proposed method is based on the assumption that minimizing the contribution of imaging parameters to measurement uncertainty corresponds to (1) maximizing image contrast and signal, (2) minimizing geometric blurring, and (3) minimizing image noise and CT artifacts. It also requires information about the workpiece nominal geometry and material composition. The proposed method calculates the optimal photon energy for precise surface determination, given the workpiece position and orientation. Tube voltage and prefilter are determined so that the resulting x-ray spectrum has an effective energy equal to the optimal energy and beam hardening artifacts are minimized. Tube current is chosen to maximize image signal, while avoiding blurring and excessive generated tube power. Exposure time is chosen as the shortest time that fully exploits the detector dynamics. The proposed method was validated by analyzing the standard deviations of CT measurements on a test phantom. An analysis of variance on the uncertainty components showed that the predicted parameters were globally optimal.

Monte Carlo dose in a prosthesis phantom based on exact geometry vs streak artefact contaminated CT data as benchmarked against Gafchromic film measurements

PurposeIn radiotherapy, accurate calculation of patient radiation dose is very important for good clinical outcome. In the presence of metallic implants, the dose calculation accuracy could be compromised by metal artefacts generated in computed tomography (CT) images of patients. This study investigates the influence of metal-induced CT artefacts on MC dose calculations in a pelvic prosthesis phantom. MethodsA pelvic phantom containing unilateral Ti prosthesis was CT-scanned and accurate Hounsfield unit (HU) values were assigned to known materials of the phantom as opposed to HU values produced through the artefact CT images of the phantom. Using the DOSXYZnrc MC code, dose calculations were computed in the phantom model constructed from the original CT images containing the artefacts and artefact-free images made from the exact geometry of the phantom with known materials. The dose calculations were benchmarked against Gafchromic EBT3 film measurements using 15 MeV electron and 10 MV photon beams. ResultsThe average deviations between film and MC dose data decreased from 3 ± 2% to 1 ± 1% and from about 6 ± 2% to 3 ± 1% for the artefact and artefact-free phantom models against film data for the electron and photon fields, respectively. ConclusionsFor the Ti prosthesis phantom, the presence of metal-induced CT artefacts could cause dose inaccuracies of about 3%. Construction of an artefact-free phantom model made from the exact geometry of the phantom with known materials to overcome the effect of artefacts is advantageous compared to using CT data directly of which the exact tissue composition is not well-known.

Effect of external fixation rod coupling in computed tomography

External fixation is a common tool in the treatment of complex fractures, correction of limb deformity, and salvage arthrodesis. These devices typically incorporate radio-opaque metal rods/struts connected at varying distances and orientations between rings. Whilst the predominant imaging modality is plain film radiology, computed tomography (CT) may be performed in order for the surgeon to make a more confident clinical decision (e.g. timing of frame removal, assessment of degree of arthrodesis). We used a fractured sheep leg to systematically assess CT imaging performance with a Discovery CT750 HD CT scanner (GE Healthcare) to show how rod coupling in both traditional Ilizarov and hexapod frames distorts images. We also investigated the role of dual-energy CT (DECT) and metal artefact reduction software (MARS) on the visualisation of the fractured leg. Whilst mechanical reasons predominantly dictate the rod/strut configurations when building a circular frame, rod coupling in CT can be minimised. Firstly, ideally, all or all but one rod can be removed during imaging resulting in no rod coupling. If this is not possible, strategies for configuring the rods to minimise the effect of the rod coupling on the region of interest are demonstrated, e.g., in the case of a four-rod construct, switching the two anterior rods to a more central single one will achieve this goal without particularly jeopardising mechanical strength for a short period. It is also shown that the addition of DECT and MARS results in a reduction of artefacts, but also affects tissue and bone differentiation.

Practical guidelines for handling head and neck computed tomography artifacts for quantitative image analysis

Radiomics studies have demonstrated the potential use of quantitative image features to improve prognostic stratification of patients with head and neck cancer. Imaging protocol parameters that can affect radiomics feature values have been investigated, but the effects of artifacts caused by intrinsic patient factors have not. Two such artifacts that are common in patients with head and neck cancer are streak artifacts caused by dental fillings and beam-hardening artifacts caused by bone. The purpose of this study was to test the impact of these artifacts and if needed, methods for compensating for these artifacts in head and neck radiomics studies. The robustness of feature values was tested by removing slices of the gross tumor volume (GTV) on computed tomography images from 30 patients with head and neck cancer; these images did not have streak artifacts or had artifacts far from the GTV. The range of each feature value over a percentage of the GTV was compared to the inter-patient variability at full volume. To determine the effects of beam-hardening artifacts, we scanned a phantom with 5 cartridges of different materials encased in polystyrene buildup. A cylindrical hole through the cartridges contained either a rod of polylactic acid to simulate water or a rod of polyvinyl chloride to simulate bone. A region of interest was drawn in each cartridge flush with the rod. Most features were robust with up to 50% of the original GTV removed. Most feature values did not significantly differ when measured with the polylactic acid rod or the polyvinyl chloride rod. Of those that did, the size of the difference did not exceed the inter-patient standard deviation in most cases. We conclude that simply removing slices affected by streak artifacts can enable these scans to be included in radiomics studies and that contours of structures can abut bone without being affected by beam hardening if needed.

Dedicated CT and MRI Techniques for the Evaluation of the Postoperative Knee.

Advances in surgical techniques, orthopaedic implant design, and higher demands for improved functionality of the aging population have resulted in a high prevalence of patients with metallic implants about the knee. Total knee arthroplasty, knee-replacing tumor prostheses, and osteosynthesis implants create various imaging artifacts and pose special challenges for the imaging evaluation with computed tomography (CT) and magnetic resonance imaging (MRI). CT artifacts can be effectively mitigated with metal artifact reduction reconstruction algorithms, dual-energy data acquisition with virtual monoenergetic extrapolation, and three-dimensional postprocessing techniques, such as volume and cinematic rendering. Artifacts related to metal implants on MRI can be reduced via optimization of the scan parameters and using advanced techniques such as multi-acquisition variable-resonance image combination, and slice encoding for metal artifact correction.

Influence of acquisition parameters on the magnitude of cone beam computed tomography artifacts.

To evaluate the influence of kilovoltage (kVp) and metal artifact reduction tool (MAR) on the magnitude of cone beam CT (CBCT) artifacts. A titanium and zirconia implants were inserted alternately in a posterior region of a mandible. CBCT exams were acquired with ProMax 3D (Planmeca Oy, Helsinki, Finland) and Picasso Trio machines (Vatech, Hwaseong, South Korea) using 70kVp, 80kVp and 90kVp with and without MAR activation. The other exposure factors remained fixed at 5mA, field of view 80 × 50 mm and voxel 0.20 mm. The scans were performed before and after the insertion of the implants. Regions of interest were determined in different distances from the artifact production area (15, 25 and 35 mm) in an axial image, in which standard deviation (SD) of grayscale values was measured and contrast-to-noise ratio (CNR) was calculated. Analysis of variance was used to compare the data. Overall, in cases where the artifact was pronounced, MAR was efficient in reducing SD values. MAR also improved the CNR of ProMax images, but did not affect the Picasso images. Additionally, the higher was the kVp, the lower was the SD value and the higher was the CNR in both machines. In both machines, increasing kVp and MAR are effective in decreasing the CBCT artifacts in all their magnitude when they are pronounced. Therefore, the professionals should choose one of those options or even both considering the purpose of the CBCT imaging and radiation dose for the patient.

A CT metal artifact reduction algorithm based on sinogram surgery.

Streak artifacts in computed tomography (CT) images caused by metallic objects limit the wider use of CT imaging technologies. There have been various attempts to improve CT images containing streak artifacts; however, most of them generate additional artifacts or do not completely eradicate existing artifacts. In this paper, we propose a novel algorithm which reduces streak artifacts in CT images. Using CT numbers reconstructed from a given sinogram, we extract the metal part M and the surrounding area C with similar CT numbers. By filling in the area C∪M with the evaluated average CT number of C, we obtain a modified CT image. Using forward projection of the modified CT image, we generate a sinogram containing information about the anatomical structure. We undertake sinogram surgery to remove the metallic effects from the sinogram, after which we repeat the procedure. We perform numerical experiments using various simulated phantoms and patient images. For a quantitative analysis, we use the relative l∞ error and the relative l2 error. In simulated phantom experiments, all l∞ errors and l2 errors approach 10% and 1% of the initial errors, respectively. Moreover, for the patient image simulations, all l∞ errors are decreased by a factor of 20 while the l2 errors are decreased less than 5%. We observe that the proposed algorithm effectively reduces the metal artifacts. In this paper, we propose a metal artifact reduction algorithm based on sinogram surgery to reduce metal artifacts without additional artifacts. We also provide empirical convergence of our algorithm.

Gout misdiagnosis due to dual-energy computed tomography artefact.

Gout misdiagnosis due to dual-energy computed tomography artefact.

Deep Learning Based Sinogram Correction for Metal Artifact Reduction

Computed Tomography (CT) is a non-invasive imaging technique that reconstructs cross-sectional images of scenes from a series of projections acquired at different angles. In applications such as airport security luggage screening, the presence of dense metal clutter causes beam hardening and streaking in the resulting conventionally formed images. These artifacts can lead to object splitting and intensity shading that make subsequent labeling and identification inaccurate. Conventional approaches to metal artifact reduction (MAR) have post-processed the artifact-filled images or interpolated the metal regions of the sinogram projection data. In this work, we examine the use of deep-learning-based methods to directly correct the observed sinogram projection data prior to reconstruction using a fully convolutional network (FCN). In contrast to existing learning-based CT artifact reduction work, we work completely in the sinogram domain and train a network over the entire sinogram (versus just local image patches). Since the information in sinograms pertaining to objects is non-local, patch-based methods are not well matched to the nature of CT data. The use of an FCN provides better computational scaling than historical perceptron-based approaches. Using a poly-energetic CT simulation, we demonstrate the potential of this new approach in mitigating metal artifacts in CT.

Soft-tissue differentiation and bone densitometry via energy-discriminating X-ray microCT

X-ray computed tomography (CT) is an important diagnostic tool in medicine as well as being an essential research technique for animal imaging and bioscience. The key aim of this study is to assess the effectiveness, in both simulation and experiment, of differentiating soft tissue from bone as well as bone densitometry, using energy-discriminating X-ray detection. Polychromatic sources, such as standard X-ray tubes, can produce similar CT numbers for materials with different compositions, making differentiation and quantification of tissue and bone extremely challenging. In addition, ‘beam-hardening’ which occurs due to the relative increase in the attenuation of low energy photons compared to high energy photons, can create significant CT artifacts. To improve material contrast and eliminate beam hardening, a number of different approaches have been developed. These include dual-energy CT using two different X-ray tube voltages, photon beam filtration, and post-processing of the data. Here we present an alternative approach using the photon counting PiXirad detector. Simulations are used to establish optimal parameters for data acquisition. This is followed by tomographic experiments performed on a phantom and a mouse embryo. The energy discriminating properties of the detector are exploited to avoid beam-hardening artefacts, to differentiate soft-tissue and bone within the mouse embryo, and to quantify bone density. Compared with polychromatic CT using an integrating detector this approach yields a number of significant advantages for materials specific imaging and quantification.

Maintaining immobilisation devices on trauma patients during CT: a feasibility study

BackgroundTo reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) scanning. A previous study found that metallic components within the inflation valve of the vacuum mattresses caused CT artefacts. The aim of our study was to investigate the effect of vacuum mattresses with plastic valves on CT artefacts, the radiation dose, and noise compared to a trauma transfer board and the spine boards currently used in our trauma system.MethodsWe scanned an anthropomorphic whole body phantom with different immobilisation devices on a 128-slice CT scanner using the standard polytrauma CT-protocol at our institution. The phantom was scanned without any immobilisation device and with three different vacuum mattresses, two spine boards, and one trauma transfer board. Two radiologists independently assessed the artefacts. Agreement between the two radiologists was measured using the kappa coefficient. The radiation dose and noise were assessed.ResultsOne spine board produced major artefacts due to its metal components. One of the vacuum mattresses resulted in artefacts that impaired clinical judgement. Otherwise, the artefacts predominantly did not impede clinical judgement and were mainly subtle. One of the vacuum mattresses resulted in no artefacts that affected clinical judgement. The overall inter-rater agreement was substantial (0.86, kappa 0.77). We did not observe any artefacts due to plastic valves. The mean CT radiation dose was slightly higher for two of the devices in the head series than that for the trauma transfer board, used as the standard in our system. Only marginal differences were noted for the other devices and series. Small differences in image noise were found between the devices.ConclusionsOur results indicate that it is feasible to maintain some vacuum mattresses with plastic valves on trauma patients during CT scanning. The tested mattresses did not result in a considerably increased radiation dose or artefacts that hampered clinical judgement. One of the tested vacuum mattresses produced no artefacts that hampered clinical judgement whatsoever.

Simulation-based artifact correction (SBAC) for metrological computed tomography

Computed tomography (CT) is a valuable tool for the metrolocical assessment of industrial components. However, the application of CT to the investigation of highly attenuating objects or multi-material components is often restricted by the presence of CT artifacts caused by beam hardening, x-ray scatter, off-focal radiation, partial volume effects or the cone-beam reconstruction itself. In order to overcome this limitation, this paper proposes an approach to calculate a correction term that compensates for the contribution of artifacts and thus enables an appropriate assessment of these components using CT. Therefore, we make use of computer simulations of the CT measurement process. Based on an appropriate model of the object, e.g. an initial reconstruction or a CAD model, two simulations are carried out. One simulation considers all physical effects that cause artifacts using dedicated analytic methods as well as Monte Carlo-based models. The other one represents an ideal CT measurement i.e. a measurement in parallel beam geometry with a monochromatic, point-like x-ray source and no x-ray scattering. Thus, the difference between these simulations is an estimate for the present artifacts and can be used to correct the acquired projection data or the corresponding CT reconstruction, respectively. The performance of the proposed approach is evaluated using simulated as well as measured data of single and multi-material components. Our approach yields CT reconstructions that are nearly free of artifacts and thereby clearly outperforms commonly used artifact reduction algorithms in terms of image quality. A comparison against tactile reference measurements demonstrates the ability of the proposed approach to increase the accuracy of the metrological assessment significantly.

Recent progress on X-ray security inspection technologies

Emerging terrorist attacks seriously impacted the global security situation which brings unprecedented challenges to public transportation. Effectual anti-terrorist ways to protect personal safety and assets security become an important global demand. Consequently, to improve security inspection capabilities with state-of-art technology has long been a serious issue and hot research topic. Recent years, with the rapid development of X-ray detection technology, utilizing X-rays to inspect hidden explosives and contrabands in cargo, luggage, vehicle and on human body become both effective and efficient. Based on different X-ray interaction behaviors with matter, a variety of inspection techniques have been researched and developed which show great potentials for security applications. This paper provides a general review on different X-ray inspection techniques such as X-ray transmission imaging, backscatter imaging, phase-contrast imaging, spectral imaging, CT reconstruction, X-ray diffraction and so on. Basic physical mechanisms, research progresses and application features are investigated. And outlooks to new technologies and applications are given. X-ray transmission imaging detects the attenuation of X-ray flux while penetrating objects. The transmission image has a strong discrimination for high-density materials with strong X-ray absorption, such as guns, knives, grenades, detonators and other high atomic number items. Dual-energy X-ray imaging is an important complement that provides preliminary material classification capability. The technology has been widely used for sea freight cargo and passenger luggage inspection. X-ray back-scatter imaging detects X-rays that reflects from the scanned objects (e.g., vehicle, container and human body). It is good for imaging low density (or low atomic number) materials. The source and detectors of the scanning device are usually designed on one side of the target object, and a rotating wheel with pencil beam collimators is the key to scan in a point-by-point method. Computed tomography (CT) inspection system generates volumetric image of scanned item. It provides high resolution 3D inner structures nondestructively and without overlap. Due to the rapid development in CT reconstruction theory, various applications for security inspection have emerged. Hot research and development topics include material classification method, dual-energy and multi-energy CT imaging, non-spiral trajectory CT scan, artifacts correction and scan speed improvement. X-ray diffraction (XRD) technique has been widely used to identify minerals and other crystalline materials. It also shows good ability for detecting drug, explosives and hazardous liquids in security examination. Photo-counting detectors are utilized to measure scatter flux on different photon energy levels to form diffraction spectrum. Currently research on XRD for security application is focused on improving signal-to-noise ratio, reducing scanning time, material recognition method and system design. Phase-contrast imaging (PCI) calculates X-ray phase-shift when traversing the item. For low atomic number materials the cross section of the phase-shift can achieve up to 103 times larger than the one of attenuation. Thus it gains much better image contrast for fruits, clothes, drugs, liquids and other low atomic number items. Grating-based imaging has been regarded as the most promising PCI method because it is a first approach that requires only conventional X-ray source rather than synchrotron or micro-focus X-ray sources. Preliminary research work can be found on the security application potentials of grating-based PCI systems and methods.

Dual-energy CT with virtual monochromatic images and metal artifact reduction software for reducing metallic dental artifacts.

Background Metallic dental prostheses may degrade image quality on head and neck computed tomography (CT). However, there is little information available on the use of dual-energy CT (DECT) and metal artifact reduction software (MARS) in the head and neck regions to reduce metallic dental artifacts. Purpose To assess the usefulness of DECT with virtual monochromatic imaging and MARS to reduce metallic dental artifacts. Material and Methods DECT was performed using fast kilovoltage (kV)-switching between 80-kV and 140-kV in 20 patients with metallic dental prostheses. CT data were reconstructed with and without MARS, and with synthesized monochromatic energy in the range of 40-140-kiloelectron volt (keV). For quantitative analysis, the artifact index of the tongue, buccal, and parotid areas was calculated for each scan. For qualitative analysis, two radiologists evaluated 70-keV and 100-keV images with and without MARS for tongue, buccal, parotid areas, and metallic denture. The locations and characteristics of the MARS-related artifacts, if any, were also recorded. Results DECT with MARS markedly reduced metallic dental artifacts and improved image quality in the buccal area ( P < 0.001) and the tongue ( P < 0.001), but not in the parotid area. The margin and internal architecture of the metallic dentures were more clearly delineated with MARS ( P < 0.001) and in the higher-energy images than in the lower-energy images ( P = 0.042). MARS-related artifacts most commonly occurred in the deep center of the neck. Conclusion DECT with MARS can reduce metallic dental artifacts and improve delineation of the metallic prosthesis and periprosthetic region.

Full and hybrid iterative reconstruction to reduce artifacts in abdominal CT for patients scanned without arm elevation.

Background Abdominal computed tomography (CT) without arm elevation is associated with degraded image quality due to streak artifacts. Purpose To compare the degree of streak artifacts in abdominal CT images without arm elevation between full iterative reconstruction (IR), hybrid IR, and filtered back projection (FBP) using two commercially available scanners. Material and Methods First, a phantom study simulating CT examination without arm elevation was performed. Second, unenhanced axial images of 33 patients (17 and 16 patients for each vendor) who underwent CT without arm elevation were reconstructed with full IR, hybrid IR and FBP. A radiologist placed 50 parallel lines with lengths of 50 pixels vertical to the streaks and quantitatively evaluated the images for streak artifacts in the phantom study. Two radiologists evaluated the images of patients for streak artifacts (on the liver and the kidney) and diagnostic acceptability using a four-point scale. Results The phantom study indicated that full IR algorithms were more effective than FBP in reducing streak artifacts. In the clinical patient study, streak artifacts were significantly more reduced with full IR compared with FBP in both the liver and kidney ( P < 0.012). Streak artifact reduction was limited with hybrid IR. Model-based iterative reconstruction (MBIR) (one of the full IR algorithms) provided diagnostically more acceptable image quality ( P < 0.016) compared with FBP. Conclusion In abdominal CT without arm elevation, full IR enabled a more efficient streak artifact reduction compared with FBP and MBIR was associated with diagnostically more acceptable images.

Experimental validation of a multi-energy x-ray adapted scatter separation method

Both in radiography and computed tomography (CT), recently emerged energy-resolved x-ray photon counting detectors enable the identification and quantification of individual materials comprising the inspected object. However, the approaches used for these operations require highly accurate x-ray images. The accuracy of the images is severely compromised by the presence of scattered radiation, which leads to a loss of spatial contrast and, more importantly, a bias in radiographic material imaging and artefacts in CT. The aim of the present study was to experimentally evaluate a recently introduced partial attenuation spectral scatter separation approach (PASSSA) adapted for multi-energy imaging. For this purpose, a prototype x-ray system was used. Several radiographic acquisitions of an anthropomorphic thorax phantom were performed. Reference primary images were obtained via the beam-stop (BS) approach. The attenuation images acquired from PASSSA-corrected data showed a substantial increase in local contrast and internal structure contour visibility when compared to uncorrected images. A substantial reduction of scatter induced bias was also achieved. Quantitatively, the developed method proved to be in relatively good agreement with the BS data. The application of the proposed scatter correction technique lowered the initial normalized root-mean-square error (NRMSE) of 45% between the uncorrected total and the reference primary spectral images by a factor of 9, thus reducing it to around 5%.

Approaches to reducing photon dose calculation errors near metal implants.

Dose calculation errors near metal implants are caused by limitations of the dose calculation algorithm in modeling tissue/metal interface effects as well as density assignment errors caused by imaging artifacts. The purpose of this study was to investigate two strategies for reducing dose calculation errors near metal implants: implementation of metal-based energy deposition kernels in the convolution/superposition (C/S) dose calculation method and use of metal artifact reduction methods for computed tomography (CT) imaging. Both error reduction strategies were investigated using a simple geometric slab phantom with a rectangular metal insert (composed of titanium or Cerrobend), as well as two anthropomorphic phantoms (one with spinal hardware and one with dental fillings), designed to mimic relevant clinical scenarios. To assess the dosimetric impact of metal kernels, the authors implemented titanium and silver kernels in a commercial collapsed cone C/S algorithm. To assess the impact of CT metal artifact reduction methods, the authors performed dose calculations using baseline imaging techniques (uncorrected 120 kVp imaging) and three commercial metal artifact reduction methods: Philips Healthcare's o-mar, GE Healthcare's monochromatic gemstone spectral imaging (gsi) using dual-energy CT, and gsi with metal artifact reduction software (mars) applied. For the simple geometric phantom, radiochromic film was used to measure dose upstream and downstream of metal inserts. For the anthropomorphic phantoms, ion chambers and radiochromic film were used to quantify the benefit of the error reduction strategies. Metal kernels did not universally improve accuracy but rather resulted in better accuracy upstream of metal implants and decreased accuracy directly downstream. For the clinical cases (spinal hardware and dental fillings), metal kernels had very little impact on the dose calculation accuracy (<1.0%). Of the commercial CT artifact reduction methods investigated, the authors found that o-mar was the most consistent method, resulting in either improved dose calculation accuracy (dental case) or little impact on calculation accuracy (spine case). gsi was unsuccessful at reducing the severe artifacts caused by dental fillings and had very little impact on calculation accuracy. gsi with mars on the other hand gave mixed results, sometimes introducing metal distortion and increasing calculation errors (titanium rectangular implant and titanium spinal hardware) but other times very successfully reducing artifacts (Cerrobend rectangular implant and dental fillings). Though successful at improving dose calculation accuracy upstream of metal implants, metal kernels were not found to substantially improve accuracy for clinical cases. Of the commercial artifact reduction methods investigated, o-mar was found to be the most consistent candidate for all-purpose CT simulation imaging. The mars algorithm for gsi should be used with caution for titanium implants, larger implants, and implants located near heterogeneities as it can distort the size and shape of implants and increase calculation errors.

Unusual Brain Computed Tomography Artifact in Cerebellum Mimicking Hemorrhage: A Case Report

Unusual Brain Computed Tomography Artifact in Cerebellum Mimicking Hemorrhage: A Case Report